I very much like Vitreq’s new Tissue Manipulator. The more I work with it, the more I have the impression that it is an indispensable instrument.

Professor Hassan Mortada is Professor of Ophthalmology and a Vitreoretinal Consultant at Cairo University, in Egypt. Having obtained a Masters Degree in Ophthalmology, Hassan Mortada was appointed as an assistant lecturer and a faculty member in the Department of Ophthalmology at Cairo University. Shortly afterwards, he joined the Illinois University in the US, for a Retina Fellowship in the Department of Ophthalmology. Five years later, he returned to Cairo and was appointed Assistant Professor in the Department of Ophthalmology, and within another five years, was awarded a Professorship in Ophthalmology.

Professor Mortada is a Board Member of the Egyptian Ophthalmologic Society and the Egypt Vitreoretinal Society. On an international level, Mortada is a Board Member at the European Vitreoretinal Society (EVRS). He is also involved in many scientific programs to advance retina education through national conferences, and is working closely with national retinal societies in Romania, Jordan, Syria, Qatar, Brazil, Greece, Russia, Azerbaijan and Turkey.

What experience have you had of working directly with companies to develop new instruments and/or surgical techniques? What are the benefits and/or limitations of working directly with companies?

I use instruments from all companies. I do not favor one single company, but select the best instrument for my work from whatever I feel is appropriate. I usually give feedback on the instruments that I use, such as visualization systems, microscopes, the vitrectomy machines; but I don’t generally know what the companies do with this feedback. I know that they do, sometimes, consider this individual feedback, and sometimes, when I meet representatives from that company in the next meeting or they visit in the hospital they tell me that they have considered that specific feedback.

What is your first impression of Vitreq’s instrumentation?

I have had chance to try Vitreq’s Tissue Manipulator. I have used this instrument in some simple and some more complicated cases and have found it very useful in the following situations:

elevating and peeling of adherent cortical vitreous, whether the retina is attached or detached.

In PVR, PDR and perforating trauma cases, it is safe and effective in opening adherent retinal folds by peeling friable membranes that cannot be effectively grasped with forceps.

Elevating the edge and peeling of moderately adherent epi-macular membranes.

In using the side of the manipulator, it is effective in starting the peeling of the ILM, by creating a flap that can be grasped by forceps or to continue peeling with the manipulator itself.

In the ILM inverted flap technique, it can be used to manipulate the flap, under PFCL, and bring it over the macular hole.

I very much like Vitreq’s new Tissue Manipulator. It is much gentler on the retina than other diamond-dusted instruments. The more I work with it, the more I have the impression that it is an indispensable instrument.

What do you expect to see developing in the near future in VR surgery?

I think there will be more innovations in pharmacology in relation to VR surgery. Better staining for the ocular tissues is definitely required. I think the use of intraoperative OCT will develop and will start to play a part in perfecting surgery. Also maybe illumination systems will change and LED lamps will be more and more used as endoillumination. Maybe the pump combining the advantages of both the venturi and peristaltic pumps will come to the fore in a better engineered way.

What are your own priority focus areas for the next few years- either in research or clinical practice?

I am already doing full macular translocation and although it is not as commonly performed as before, in my opinion, it carries a better long term prognosis for the patients. Choroidal grafts might be an area for us to improvement in the future, through development of better techniques of obtaining grafts. Or the use of RPE, maybe cultured RPE cells could have a role in certain diseases, in which patients undergo pathological atrophy, like myopia and AMD, and in other diseases affecting the colloid capillary. Maybe photoreceptors will be important in the future. And stem cells. The use of artificial vision maybe the future for cases of congenital or inherited diseases, although I am not working on that. I think the future is full of ideas.

Which procedure currently proves the most challenging to you in your daily practice and what could be improved?

In the past, full macular translocation was a very challenging surgery, but I think that nowadays, operating on the pediatric retina has become the biggest challenging, whether operating on eyes with ROP (Retinopathy of Prematurity) or rhegmatogenous retinal detachment, in the pediatric age group. Cases like Stickler syndrome, congenital myopia, Marfan syndrome, eyes with coloboma, optic disc coloboma or chorio-retinal colobomas, are also challenging. Operating on Stage 4 or 5 ROP requires just the necessary work, and you must know when to stop. Small eyes move differently to adult eyes within the orbit. The nature of the tissues is different, and adhesion of the vitreous to the underlying retina presents challenges, especially in cases of eyes with Stickler syndrome and congenital myopia, developing retinal detachment. It is particularly challenging to detach the posterior hyaloid in these cases. Although this is an essential step of the operation, we need to find ways to improve it: maybe by working bi-manually to detach the posterior hyaloids, as much as possible. And obviously, you have to remove the ILM in pediatric rhegmatogenous retinal detachment, because the risk of reproliferation is very high. I strongly believe that removing the ILM over the largest area possible plays an important part in controlling reproliferation over the macular areas. Many trauma cases in children are also challenging – because of the already mentioned difficulties, and additionally, the presence of foreign bodies, deep impacted injuries, difficult visibility, especially if the cornea is injured, and how to manage the anterior segment.

Do you think that other Vitreq instrumentation will be valuable in your own work in the future?

I am sure of that. I know the owners of Vitreq and they have extensive and long-standing experience in developing instruments. I think Vitreq have good connections with doctors and VR surgeons all over the world and can develop better instruments as a result.

What do you envisage Vitreq’s role in the market to be?

It will soon have a big part of the market. The owners are trustworthy and have a good reputation.